Attention deficit hyperactivity disorder and trauma.
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Attention Deficit Disorder with Hyperactivity↗
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Reading Loewald: Oedipus reconceived.
Loewald's 'Waning of the Oedipus complex' is a watershed paper in the history of psychoanalytic thought. By means of a close reading of Loewald's paper, the author frames, discusses and clinically illustrates his understanding of Loewald's reconceptualization of the Oedipus complex. The principal elements of Loewald's reformulation include: 1) the idea that the tension between the pressures of parental infl uence and the child's innate need to establish his own capacities for originality lies at the core of the Oedipus complex; 2) the notion that oedipal parricide is driven, most fundamentally, by the child's 'urge for emancipation.' Parricide involves a revolt against, and an appropriation of, parental authority; 3) the idea that the child atones for the act of parricide by internalizing a transformed version of the child's experience of the oedipal parents. This results in an alteration of the very structure of the child's self (i.e. in the formation of the superego as the agency of autonomy and responsibility); 4) the notion that, in the child's appropriation of parental authority, he in reality 'kill[s] something vital in them...[thus] contributing to their dying' and to the succession of generations; and 5) the idea that the incestuous component of the Oedipus complex involves, in health, the creation of a transitional incestuous object relationship which, over the course of one's life, mediates the interplay between undifferentiated and differentiated aspects of self and relatedness to others. The author concludes with a comparison of Freud's and Loewald's conceptions of the Oedipus complex.
Child↗
What is the function of faith and trust in psychoanalysis?
Unlike other concepts such as 'illusion', 'capacity to tolerate frustration' and 'libidinal investment', the concept of faith has not yet found a well-defined position in psychoanalytic theory. Bion focused on faith and placed it in an unusual context: scientific work. Through the Act of Faith a researcher can give some consistency to certain ideas, hunches or intuitions that may appear during observation, though he cannot represent them by existing theory. Through the Act of Faith an analyst can 'see', 'hear' and 'feel' those mental phenomena, the reality of which leaves no practising psychoanalysts in doubt, even if they cannot represent them by current formulations. In this paper, the author aims to expand Bion's proposals into the clinical and therapeutic fields. In the first part, the author examines how faith and trust overlap, and how they depart from each other; and he gives an example. Faith possesses an igniting and driving force which trust doesn't possess to the same extent. In the second part, the author looks at F as a psychic function of the analyst, which aids him in supporting a depressed and hopeless patient while waiting for the return of the patient s desire to live. In the final part, he focuses on F from the patient point of view and studies the transformations of F that may occur during an analysis.
Adult↗
Experiences in K and -K.
In this paper the author explores and expands Bion's concepts of K and -K and delineates the nature of the relationship between the two. While Bion views envy as a principal motivating force for -K, his conception of -K goes considerably beyond this. The author explores manifestations of -K not driven by envy and, consequently, not necessarily pathological or pathogenic. -K is viewed by the author as a psychological process, which may serve many functions, including the communication of the patient's fear that knowing will bring on psychological catastrophe. -K, under circumstances that he describes, may serve to protect the individual's sense of continuity of being. The need to know the truth (K) may be at odds with the need to survive psychically, for example, when a person fears that the truth will kill him, or those he loves and depends upon. This idea is explored in two ways: first, by means of a discussion of the Oedipus myth in which Oedipus attempts to evade knowing for fear of recognizing that a prophesied catastrophe has already occurred; and, second, by means of a clinical exploration of the conflict between the need to know and the need to survive. The author discusses his analytic work with a severely disturbed patient for whom not knowing was felt to be essential to her psychic survival. Her need not to know reached a point where she psychically obliterated the analyst through the use of negative hallucination.
Adult↗
Two hours at work, with Amanda.
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Adolescent↗
Acute enactment as a 'resource' in disclosing a collusion between the analytical dyad.
The author discusses various aspects of the function of enactment in analytical practice, reviewing the concept, then describing a borderline patient with whom the analytic process seemed to be developing productively. Following a change in the setting, an intense, acute enactment took place. Understanding this led to observation of an unconscious collusion, in which a symbiotic relationship had been established between the patient, the analyst and his family, as a chronic enactment. This relationship had prevented the analyst from touching on highly destructive unconscious fantasies and archaic traumatic situations. Comprehension of the enactment enabled the collusion to be dissolved. The author suggests that, besides the resistance aspect, the collusion may have been useful in strengthening the patient's mental mechanisms and trust in the analytical work, which required some time. The acute enactment arose, unveiling the collusion, when the patient and the analyst felt able to face the terrible feelings related to the triangular situation. He speculates that both enactments may occur in the analysis of these kinds of patients, as part of the 'natural history' of the analytical process, and their function is to relive archaic experiences in the analysis, also with the aim of working them through. Finally, the author proposes a classification of enactments: normal, pathological, acute and chronic.
Acting Out↗
The plays of Tennessee Williams--a psychoanalytic view.
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Conflict, Psychological↗
Who is 'who' in dissociation?: A plea for psychodynamics in a time of trauma.
Contemporary theories of dissociation and trauma for the most part have evolved outside of psychoanalysis. Psychoanalytic writings have also been regarded as being in opposition to trauma-based notions of human psychopathology. The specific psychoanalytic contribution--the emphasis on unconscious conflict and meaning--is for the most part excluded from the discourse on dissociation, often resulting in a 'mechanic' conceptualisation of trauma. In this paper, based on clinical material, the author argues in favour of including conflict, unconscious intention and personal meaning in understanding the kind of dissociation we see in cases of multiple personality pathology. Textual analysis of letters written to the analyst illustrates how events of abuse are defensively elaborated. The author demonstrates that patterns of affect regulation and dominant object-relational strategies can be captured through analysis of the discourse structure. She focuses on how an organised character pattern, revealed mainly through narrative style and the analyst's countertransference, serves protective purposes as well as wish-fulfillment. She argues that dissociation in the form of multiple personalities may imply an active, strategic agent.
Adult↗
The many faces of lying.
In this paper the author explores the psychic functions of lying and draws on Glasser's (1979) notions of self-preservative and sadistic violence to identify three selfobject configurations. Each of these is associated with specific anxieties to which the lie offers an apparent solution. The first configuration is sadistic lying. Here the intent is to attack and triumph over the duped other. The lie allows the object to be controlled and humiliated. This gratifies the self by reversing an earlier humiliation. The second and third configurations are both forms of self-preservative lying, where the lie may be best conceived as a 'symptom of hope' (Winnicott, 1985). In the second configuration, the object is felt to be unavailable or inscrutable. The lie may be used to create an attractive self that will elicit the object's love, admiration and concern. In this way, the lie serves to eliminate doubt about the object's intentions towards the self. In the third configuration, the object is felt to be intrusive, and the dyadic relationship is overpowering. Here the lie can represent an attempt to insert a third into the relationship.
Adult↗
Early trauma and narcissism-autism bipolarity.
The analyst makes a series of considerations taken--a posteriori--from the analysis of a small number of patients. These patients have saved themselves from an early narcissistic catastrophe by developing precocious mental processes, while affective relationships rudimentarily repeat the impact with the original trauma. Primitive defences, essentially denial and vertical splitting, dissociate the tear in the psyche and structure a 'narcissism-autism bipolarity', revealed in aspects of the character which oblige the patient to automatically repeat a single matrix of experience. In therapy, it is necessary to construct a 'first time of the trauma', by finding and linking threads of the primary relationship and strengthening them in the analytic relationship. This reconstruction of the background, a screen to project what had originally been rejected, is the prerequisite for coming out, in deferred action, from the hold of the pathological identifications. The author dedicates particular attention to the undifferentiated background, the nature-environment torn by the trauma, and to the need to reconstruct this fabric of experience in the analytical relationship, as a fundamental element to the recomposition of the dissociated nuclei. In the clinical case, the analyst describes in particular how the analyst's words encounter an unbridgeable gap, a failure in the capacity for representation when opening the autistic nucleus. Through a regression lasting for about a year, a patient was able to live the experience of 'primitive agonies' and that of an unbearable helplessness and, at the same time, was able to feel how the analyst supported her sense of existence. Subsequently, the patient was able to give shape, through visual images, to deep states of being and start the process of metabolising and symbolising the trauma.
Adult↗
A transitory homosexual passion in the course of an analytic treatment.
Do homosexualities express a sexual conflict originating in bisexuality or must we look for their deep determinism in the narcissistic conflict and its vicissitudes? Two clinical sequences from the treatment of a borderline patient, which occurred during years seven and eight of treatment, a period characterised by intense drive turbulence and the unexpected occurrence of a transitory homosexual passion, will enable the reader to follow the psychical movements and evolution of the work of representation. The first sequence throws light on the links between her sudden involvement in this homosexual passion and the traumatic dangers of a breakdown of her ego's capacity for representation, linked to a reactivation in the transference of early and later traumatic traces whose reverberation in the transfero/countertransference dynamic was the source of a painful transference that was responsible for this lateral transference movement. The second sequence shows the links between the strengthening of her capacity for representation, thanks to the working through of the oedipal conflict in its two aspects, and her renunciation of this passion. The roots of this transitory homosexual passion in the deep flaws of her psychical functioning raise metapsychological questions concerning, in particular the dynamic of the 'double' ('twin') and narcissism.
Adult↗
Why perversion?: 'False love' and the perverse pact.
In this paper, the author works with the awareness that perversion is a socially, historically and theologically loaded term, at the same time as it may be the latest frontier in psychoanalysis, both clinically, and in relation to contemporary art and culture which emphasize the perverse. Positioning itself against tendencies to deny the existence of a category of 'perversion' or, inversely, to abuse it for the power that accrues from the act of diagnosing, she also points to other liabilities in the history of the treatment of this term, such as the narrowing down of perversion to the exclusively sexual domain, or, alternatively, the overextension of it to polymorphously erotic practices that enhance sexual excitement. The paradoxes of perversion and the difficulties of distinguishing the perverse from the non-perverse are addressed. The case is also made that, in order to understand perversion, one must unlink it from the narrow notion of sexual practice and see what is involved on a deeper level--an approach initiated when psychoanalysis turned to perversion as a defense against psychotic anxieties, and began considering the necessary place of perversion in the transference--countertransference. Two features common to both sexual and non-sexual perverse relations are the seductive and bribing aspects of perversion, and its means-ends reversal. Perversion is a haven for the disguising of hatred and suspicion as excitement and (false) love. Displaced child and beating father, entitled child and seductive mother, are both prototypes of psychoanalytic reflection on parents who excite, deceive and corrupt their children and establish perverse pacts with them. The notion of the perverse pact is foregrounded in Alice's analysis, where first the resurrection and then the dismantling of such a pact were effected through various analytic means.
Adult↗
Artist and model: psychoanalytic perspectives.
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Art↗
Psychoanalytical teamwork in a day hospital: revisiting some preconditions for patients' subjective appropriation.
Psychoanalytical 'teamwork' may be recommended for dealing with a particular kind of transference that characteristically occurs during the institutional treatment of young patients presenting psychotic or behavioural symptoms. In such cases, the degree of alienation is such that repetition is usually induced in other people (the therapists), filling in for fantasy construction that seems to be lacking in the patient's psyche. A case like that of 'Angel' can give some idea of this phenomenon, wherein several caregivers have to harbour fragmented and incompatible elements of the case's particular history, which are in need of more mental representation. Any subjective restitution and appropriation of these elements by the patient would require a sort of detour (often a trying one!) by way of the psychical space of caregivers whose initial task will be to 'work it through' among themselves.
Adolescent↗
Variations on the concept of traumatism: traumatism, traumatic, trauma.
In this paper, the author outlines Freud's fundamental hypotheses concerning the concept of traumatism, then goes on to differentiate three notions (French being a particularly apposite language for such a venture): 'traumatism', 'traumatic' (in a substantive sense) and 'trauma'. These three terms correspond to the three turning points in Freud's theory with respect to the concept of traumatism (1895-97, 1920, 1938). The author evokes also the developments that are due to Ferenczi, particularly in his later writings (1928-33), where he defined and discussed the question of 'trauma' in contemporary clinical practice; the author goes on to explore the different variations on this theme as regards mental functioning. He then defines, from a metapsychological point of view, the differences between 'traumatisms' that have been 'worked over by secondary processes', organised and governed by the pleasure-unpleasure principle ('traumatism') and 'early' or 'primary traumatisms', which interfere with the process of binding the instinctual drives ('trauma'); states of mind influenced by a traumatic imprint ('traumatic') are looked upon as belonging to both categories of the above mentioned traumatisms. The author illustrates his hypotheses with a clinical example.
Adaptation, Psychological↗
Theoretical and technical approaches to the clinical case: advantages and disadvantages of present-day pluralism.
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Adult↗